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Animal Assisted Therapy As An Adjunct To OT

Animal Assisted Therapy As An Adjunct To OT
Melissa Winkle, OTR/L, FAOTA, CPDT-KA, Phoebe Yam, OTD, OTR/L
January 24, 2022

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Editor's note: This text-based course is a transcript of the webinar, Animal-Assisted Therapy As An Adjunct To OT, presented by Melissa Winkle, OTR/L, FAOTA, CPDT-KA, Phoebe Yam, OTD, OTR/L.

Learning Outcomes

  • After this course, participants will be able to recognize accurate terminology related to AAT.
  • After this course, participants will be able to identify the ethics involved with the inclusion of AAT.
  • After this course, participants will be able to identify an AAT professional development plan for both human and animal partners.

OT Practice Framework (4th Ed)

  • Care of pets and animals is an occupation under instrumental activities of daily living (IADLs).
  • Description: "Providing care for pets and service animals, arranging or supervising care for pets and service animals" (AOTA, 2020b).
  • According to the APPA (2021), 70% of US households own pets.

Phoebe: Let's begin by talking a bit about how animal-assisted therapy can fit into occupational therapy. If you look at the OT Practice Framework, care of pets and animals is an occupation under instrumental activities of daily living. The description is as follows: "Providing care for pets and service animals, arranging or supervising care for pets and service animals." It is within our scope of practice to work with clients who have difficulty caring for their pets or service animals. According to the American Pet Products Association (2021), 70% of US households have pets. This statistic tells us that caring for pets and animals is a meaningful occupation for many and is part of a daily routine for the US population. When a person has a disability that causes them to be unable to participate in meaningful occupations and roles, OTs provide strategies, modifications, adaptations that allow their clients to continue doing what they love, including caring for pets. 

Terminology: Animal-Assisted Interventions

  • Animal-Assisted Activities (AAA)
  • Animal-Assisted Education (AAE)
  • Animal-Assisted Therapy (AAT)

Animal-assisted intervention is a categorical term used to describe a volunteer, an educator, and a practitioner, including an animal in practice. Animal-assisted interventions (AAI) include animal-assisted activities (AAA), animal-assisted education (AAE), and animal-assisted therapy (AAT).

Animal-Assisted Activities (AAA)

In animal-assisted activities, the animals are specifically selected and trained. The human-animal teams are evaluated together to see how the dog interacts, whether they enjoy the interactions and whether they can calmly approach people. Can the human modulate the interactions between the dog and the stranger and identify if the dog enjoys the exchange or feels uncomfortable or stressed? 

The human-animal teams can be volunteer, paraprofessional, or professional, and the interactions can be unstructured or goal-oriented towards social, motivational, recreational, or general well-being. The interaction should benefit both the humans and animals involved. If you look at this picture in Figure 1, the dogs have approached this human. They have said hello and are enjoying getting petted.

Figure 1

Figure 1. Example of an animal-assisted activity with dogs getting petted by a human.

In animal-assisted activity, the dogs typically hang out, say hello, and not do any tricks. This type of intervention can be seen in hospitals, libraries, or senior centers. 

Animal-Assisted Education (AAE)

Animal-assisted education is a goal-directed, educationally relevant teaching plan that promotes the development of cognition, social functioning, personal growth, and responsible pet caregiving. The provider is usually licensed, degreed, or has an equivalent in education. Their specialized expertise is in teaching or education, and the process is evaluated and documented throughout. As you can see in Figure 2, the child might be learning to read to the dog, and her specific goal might be literacy.

Figure 2

Figure 2. Example of animal-assisted education with a girl reading to a dog.

Other programs are in the classroom, special education, or formal literacy programs. 

Animal-Assisted Therapy (AAT)

  • Goal-directed therapeutic/intervention plans promote improvement in:
    • Physical
    • Cognitive
    • Psychosocial
    • Behavioral
    • Emotional functioning
  • Provider is educated, licensed/degreed/ equivalent in healthcare/human service.
  • Specialized CE, experience, and expertise within the profession's scope of practice
  • Process is evaluated and documented (AAII, n.d.)

The last one is animal-assisted therapy conducted by occupational therapists, nurses, counselors, or social workers. These are goal-directed therapeutic intervention plans that promote physical, cognitive, psychosocial, behavioral, and/or emotional functioning. Again, the provider is educated and licensed. OTs are licensed, work within our scope of practice, and have specialized continuing education. Finally, the process is evaluated and documented. Figure 3 shows a picture of my dog doing animal-assisted therapy.

Figure 3

Figure 3. Example of a girl in animal-assisted therapy.

The therapist is trained to be in this environment, with a specific population, and work on individual goals. Her goals might be sensory integration, motor planning, body awareness, and stuff like that. 

OT Code of Ethics Principles

We will look at the OT Code of Ethics Principles and relate it to animal-assisted therapy.

Beneficence

  • "concern for the well-being and safety of persons" (AOTA, 2020a)
  • Practitioner has achieved competency for AAT

Beneficence is a concern for the well-being and safety of persons. OTs should have continuing education, training, and mentoring in animal-assisted therapy, dog behavior, and the application of positive reinforcement training methods to make sure that both the animals and the humans are safe.

Nonmaleficence

  • "refrain from actions that cause harm" (AOTA, 2020a)

The next one is nonmaleficence which is refraining from actions that cause harm. The dogs must go through extensive training and evaluation in the different work settings and populations. The trainers and the therapists should know the risks involved to ensure that the interactions do not cause harm.

Autonomy

  • respect the right to "self-determination, privacy, confidentiality, and consent" (AOTA, 2020a)

Respecting the right to self-determination, privacy, confidentiality, and consent is autonomy. The participants should know what they are signing up for, and both the dogs and humans should have a right to consent. 

Dog Consent. OTs must ensure that their clients fully understand the benefits and risks of participating in animal-assisted therapy. Dogs are given choices to participate in sessions, and they have the space to get away if they feel uncomfortable for any reason. We like to call it an "open dog door policy" where we treat in an open space with open doors. Typically, the dogs approach the humans and initiate the interactions to show consent. We do not ever have humans go after the dog. And, at any time, if the dog is feeling uncomfortable, they are allowed to walk away. We might invite them one more time and say, "Hey, would you like to come back?" However, if they stand there or walk away, that is a clear sign that they are not interested in that interaction. In this picture (Figure 4), we have a dog in a therapy session. We also have another dog in the background who is waiting.

Figure 4

Figure 4. Dog in the training room with another waiting.

Justice

  • respect the right to "self-determination, privacy, confidentiality, and consent" (AOTA, 2020a)

Occupational therapists practicing animal therapy shall ensure that they are promoting equality, inclusion, and objectivity. Additionally, they need to ensure that they follow public access laws related to animal intervention (AI) dogs versus assistance dogs in their region. OTs must understand and follow policies and procedures within their facility. They are also responsible for providing appropriate documentation of services and preparing the dog for the session. 

Veracity

  • "provide comprehensive, accurate, and objective information" (AOTA, 2020a)
  • Disclosing potential benefits & risks of AAT

Veracity is providing comprehensive, accurate, and objective information. An example would be the therapist disclosing the potential benefits of risks of participating in AAT and making sure that people know their credentials, qualifications, and any continuing education completed in animal-assisted therapy specifically. They can also provide the experience and training that the dog has.

Fidelity

  • "treat clients, colleagues, and other professions with respect, fairness, discretion, and integrity" (AOTA, 2020a)

Fidelity treats clients, colleagues, and other professions with respect, fairness, discretion, and integrity. OTs working in AAT should treat all dogs, clients, and colleagues with respect and demonstrate the ability to build rapport and establish effective working relationships with them.

One of the big things at Dogwood Therapy is relationship development and learning how to create that bond with both the clients and the dogs.

Animal-Assisted Interventions Planning

  • Resource Building
  • Preparatory Phase
  • Supervision/Mentoring or Volunteer Visiting
  • Animal-Assisted Therapy or Education

Melissa: I will talk a little more about developing your plan to do animal-assisted interventions. It is not as easy as saying, "Hey, I have a nice dog that enjoys my nephew when he comes over to my house." Animal-assisted interventions require a lot of continuing education, both for the human and the animal partner. We need to ensure that the two are a perfect match for the specific jobs created.

I have developed a four-tiered model (Figure 5) for many people to follow, whether you are somebody who is already doing animal-assisted therapy or if you are somebody who hopes to do so in the future. These are some ideas for professional development. 

Figure 5

Figure 5. Four-tiered model for animal-assisted therapy. Click the link for an enlarged image.

Reviewing these tiers, we will review what is related to the human versus the dog. We refer to dogs because that is our specialty, but this would also apply if you work with any other animal species.

Animal-Assisted Interventions Planning- Resource Building

Resource Building for Human

  • Create Human Handler Profile (Skills)
  • Review OT specific professional requirements & development
  • Review National & State Standards, Code of Conduct, Position Statements
  • Review theoretical foundations of human-animal bond/interaction literature
  • Understand breed-specific traits
  • Begin continuing education for AAIs
  • AAI Networking

The first tier is resource building. The first thing is developing a human handler profile, including preferences, strengths, interests, beliefs, animal communication, training, behavior, and background. Working with a live animal is serious and requires more training, like any other alternative or complementary practice. For example, lymphedema treatment requires additional training to provide treatment, and it is not just one time. Ongoing continuing education is needed as there are always new things to learn. We also need to review our OT-specific professional requirements and development. We need to know what the practice framework says about alternative and complementary therapies and what the AOTA says about the qualifications required to participate in specialized training? We need to review our national and state standards, codes of conduct (which Phoebe reviewed), and any position statements.

We also need to review our theoretical foundations of the human-animal bond and interaction literature as these are two very different things. A human-animal bond develops over time. You are with your animals in many different situations, but this may not be the case with your clients. An animal may bond with a few clients, but for most of our clients on our caseloads short term, it is more of an interaction. And so they may like each other and enjoy it, but that bond is not there, it's just an interaction, which has a lot of value, but we must know that there is a difference. 

There are a lot of breed-specific and individual-specific traits in animals. Many clients use walkers or adaptive equipment in a skilled nursing facility, have balance issues, and have visual impairments. A ball-crazy Heeler puppy running and jumping all over the place may not be the best option for this situation. Is there another breed that might be calmer and better in this situation? We also have to consider those individual traits that a dog may have, and we do not know those until they are a year or two years old. They change with age. We may have a dog who enjoys pediatrics and running and playing with six to 10-year-olds, but by the time that dog is six, they may have different preferences. The dog may be thinking, "Wow, I want to hang out with the teenagers or the adults," and then as they get towards their retirement age, "Hey, can I hang out with that mom in the lobby? I want to hang out and be petted." We need to think about this when we are creating these profiles for ourselves and our animals. 

We also should be taking continuing education, specifically for animal-assisted Interventions, as there is a lot of really great content out there. There is also a lot of bad content, but I would be first to raise my hand and say some of my very best lessons have come from going to bad workshops. They teach me how I do not want to engage with my animals or how I do not want my animal to engage with a population. If your gut tells you that something is not right, it probably is not right. 

The Animal-Assisted Intervention Networking is another excellent resource. Some may want to do therapy but not have an appropriate animal. We may need to tap into this network for assistance. They can be real gems in our practice. 

Resources for OTs

  • Occupational Therapy Scope of Practice
  • The Standards of Practice for Occupational Therapy
    • Occupational Therapy Code of Ethics

You can also tap into OT-specific resources like the Occupational Therapy Scope of Practice, the Standards of Practice for Occupational Therapy, and the Occupational Therapy Code of Ethics. Make sure you review those. 

Resource Building for Dog

  • Begin relationship development & socialization with animal
  • Begin education for animal communication & humane training/handling techniques
  • Explore animal welfare & well-being
  • Familiarize with enrichment activities
  • Begin creating an animal profile
  • Track preparation & training

Let's now talk about what we can expect for the animal (dog). Again, we take into account those breed-specific traits and individual-specific preferences to see if it will be a good match for what we want the dog to do. For training dogs, we want to look at both nature and nurture. As we prepare our animals, preparation and training are not the same. One of the things that we work on is relationship development and socialization. Your animal must know that you have its back no matter what. 

Consent is a tricky word. Do animals understand what will happen during this interaction with every client ahead of time? Are they able to give their permission? However, as we learn animal communication and behavior, we can get excellent indicators with whom our dogs want to interact. For example, in our practice, we have seven dogs that have been able to pick their caseload. I am not saying everybody should run out and get seven dogs, but we have noticed that specific dogs like specific things for a decent time. And even though those preferences change over time, you can bet that you are going to find our dogs excited and happy at the window when they hear the car door of their favorite client. So, we want to make sure that we know our dogs well enough to understand all of their behavior and communication. Then once they see that we have their backs, we start the socialization process. 

If you are lucky enough to get a very young puppy, many breeders do a lot of socialization when preparing animals for this kind of work. Assistance dog training organizations also train and socialize dogs for therapists. We then need to move the dogs into the communities with other humans and dogs. Most of a dog's socialization window happens until they are 16 weeks old, and then the window closes. You can see why it is vital to have a sociable dog if you did not have the opportunity to raise that dog. This does not mean they have to be up in people's faces and jumping and squealing, but there should be no fear of the population, the environment, or the activities you are hoping to do.

We want to begin education for animal communication and human training and handling techniques early as part of our relationship development. This creates a strong relationship with our dogs, so we would not expect to see a lot of punishment like choke chains, prong collars, or shock collars. You should not have to electrocute a dog to get them to participate in animal-assisted Interventions of any kind, or even as a pet. 

We want to explore animal welfare and well-being and make sure that they are healthy, happy, and have enriched lives. There are great social media pages that list enrichment activities for dogs. We want to make sure that we familiarize all of our animals with things they might encounter out in the world, including a therapy clinic, hospital setting, or in the car on the way there. We can start to create their profile and identify what the dog enjoys.

Back to our ball crazy dog example, we can work on balance, energy conservation, and using adaptive equipment. We can use long sticks to throw the ball, and this dog will run back and forth all day long. For some dogs, this can be overstimulating, and they may only want to do three to five repetitions. I need to know this information as I develop my treatment plans for all of my clients. What is my dog is interested in, what is joyful to them, what do they love, and what do they want to continue to do?

It is also my job to ensure that they do not overdo it. I do not want to burn the animal out or set my expectations too high. We need to remember that these are not circus dogs. These are animals that are participating in our session. There can be valuable lessons in being able to say, "Wow, it looks like Gertrude doesn't feel like participating right now as she is sitting by the door, squinting, and doesn't look very happy. I think she is going to go outside. If she decides to return to us, then we'll handle it from there, but if she doesn't, then maybe we need to provide her with a nice, quiet place away from all of the action". 

We also want to track their participation in training. Just because your dog is worried about one thing does not mean they are a terrible candidate for the rest of their lives. I have one dog afraid of huge men in my practice, and nobody is sure why. Since he was eight weeks old, I have had this dog, and he can get pretty fearful. The vast majority of the clients coming into the clinic are moms and nannies, but we have a few men who come in. This particular dog does okay 75% of the time after making a judgment call. The other 25% of the time, he decides to go into the office and not return. He does not demonstrate any aggressive behaviors; he removes himself from a situation, which makes him a good candidate for this. I track this preparation, training, and performance over time. 

Animal-Assisted Interventions Planning-Preparatory Phase

We need ongoing resource building and professional development options for the preparatory phase. 

Preparatory Phase-For Human

  • Ongoing resource building & professional development
  • Theoretical foundations of AAT
  • Discipline-specific & complementary literature review

There are many different ways to do this. You can go to international organizations like Animal-Assisted Intervention International or the "Human-Animal Interaction Bulletin." There are many places to get great information, including some communities within AOTA that talk about animal-assisted therapy.

We also want to make sure you understand the theoretical foundations of animal-assisted therapy. It is not a dog and pony show. We are trying to create meaningful experiences for clients and work on their goals. When watching somebody enjoy interacting with our animals, we can forget about the intended purpose. However, we need to turn that initial engagement into a goal-driven activity.

We also need to make sure that we read discipline-specific and complimentary literature reviews. There is not a whole lot of research out there right now that says, "Wow, animal-assisted therapy is a great thing." We know that it is as good as a lot of other interventions and is engaging, but you need to be familiar with the literature that is out there. There is some research about animal-assisted activity with volunteer visiting teams. But, because the word therapy is used, like "therapy dog" in the title, people assume that it is therapy when it is not. 

Animal-assisted therapy can support theoretical foundations. 

  • AAT can aid in theoretical foundations
    • Canadian Model of Occupational Performance and Engagement
    • Model of Human Occupation
    • Ecology of Human Performance
    • Social Learning Theory and Cognitive Theory
    • Ayres' Sensory Integration
    • Cognitive Orientation to Daily Occupational Performance
    • Biomechanical Frame of Reference
    • Human-Animal Relational Theory (Chandler, 2021)

Preparatory Phase-For Dog

  • Complete intermediate animal communication, preparation, and training skills
  • More community/social exploration
  • Structured skill sets (i.e., Canine Good Citizen)
  • Seek mentorship for AAIs (AAA & AAT/AAE)
  • Identify volunteer visiting organization (AAA); complete coursework

Then, we move into the preparatory phase for a dog. We want to complete intermediate animal communication, preparation, and training skills to ensure that our animals continue to explore the community. You can also get structured skill sets like the Canine Good Citizen. These extra skill sets are great for practice and give you another set of eyes on your dog. 

To become an occupational therapist, you did a lot of schooling. Then, when adding animal-assisted therapy, you add more program development. It is a lot of work to keep all of the education updated. In addition, we need to follow policies and procedures, infection control, et cetera.

Lastly, we need to pay attention to the dog side of things. We want to make sure that our dogs have lots of opportunities and different eyes on them to say, "Wow, this dog performed well. It has manners, obedience, and interest." 

Animal-Assisted Interventions Planning-Supervision/Mentoring or Volunteer Visiting

  • Ongoing resource building & professional development
  • Seek professional AAT networking & membership
  • Initiate formal program proposal plan
  • Use of appropriate AAI terminology
  • Screening of potential participants
  • Evaluate, register, and begin visiting – AAA (similar setting & population)
  • Practice animal advocacy
  • Participate in hands-on or experiential AAT opportunities

I also recommend that you seek mentorship for animal-assisted Interventions. It is great to have a mentor to ask questions and check in on you. This person should have training in animal behavior, communication, and training. You can ask this person things like, "My dog growled at a little kid. Is this normal?" Did your dog growl at the kid, or was it afraid of the stroller? Dogs can be briefly fearful of things, but this should not disqualify them from participating.

Another example is if your dog is exhibiting many signs like panting or moving away from clients. These are things that you can run by a mentor. Again, we do not want to force our dogs to participate. And, if a dog does growl at something, you should not shush that bark or growl because that is communication, and you need to figure out why. How is this behavior going to extend into the clinical environment?

It is also a good idea for you to identify volunteer visiting organizations and complete some of their coursework. Wouldn't it be a great thing to go out and do some volunteer visiting with your dog before you do animal-assisted therapy? It is an excellent opportunity to engage without being responsible for treatment plans or equipment. You are accountable for your dog and its interactions. For that supervision and mentoring piece of it, you want to have ongoing resource building and professional development on animal behavior, training, animal-assisted therapy, and animal-assisted activities. There is always great information out there. I enjoy looking at animal cognition and behaviors as that is one of my special interest areas. 

Continue seeking out professional animal-assisted therapy networking and membership. You can initiate formal program proposals, plans, and risk management. This is important to cover any liability with having an animal in practice.

Again, you also want to use the appropriate terminology. Are you doing animal-assisted therapy and using animal-assisted therapy literature? If you got a dog from an assistance dog training organization, do you understand that it is people with disabilities who have the rights and not dogs? If you are doing animal-assisted therapy, chances are they only have public access in your place of work. You should not pass them off when you go into Walmart or restaurants.

We also want to make sure that you know how to screen potential participants. Just because your clients have a dog, miss their dog, like dogs, et cetera, does not make them a good candidate. Many crazy things happen out there, especially with kiddos and elderly folks. Make sure that you learn how to screen people before taking a dog into a session.

You have to have an eagle-eye view of your dog's preferences. Your dog could be okay with people with walkers or wheelchairs but uncomfortable with people bending over them. You need to make accommodations for your dog. 

To advocate, we may say, "Wow, it looks like Gertrude doesn't want to participate right now." If we understand animal behavior, communication, training, preparation, and handling, we are building great intervention plans that include our animals. If a dog wants to leave, typically, they hear another kid in another room that they want to work with, have to go to the bathroom, or hear other noises. 

Advocating for animals is an excellent way to teach our clients to advocate for themselves. When they see us support our animals, they realize we will empower and advocate for them. I hope you participate in hands-on or experiential animal-assisted therapy opportunities. A handful of us around the country offer these kinds of weekend workshops, internships, or post-professional rotations, so look around for those.

  • Continue building animal profiles
  • Work with a mentor to identify strengths & weaknesses
  • PREVENT animal stress, fatigue, etc.
  • Familiarities with future practice setting in the absence of clients
  • Additional preparation & training for specific intervention activities
  • Prepare for evaluation for AAT
  • Establish rules of engagement for future clients

We want to continue building animal profiles for the rest of our animals' lives because, remember, as they age, their preferences change. 

Think about what you enjoy doing on the weekends right now. Remember, one of our years is seven of our dogs' lives. One year can change everything, and we want to make sure that we set them up for success.

Again, we can work with a mentor to identify strengths and weaknesses. When Phoebe was an intern, she was nervous. It can be challenging for somebody to watch in on a session instead of interacting and training. You can give them tips and tricks. "You did this well, but one thing I notice is that Summer has some issues with social pressure. She is okay with you bending over her, but she shies away when kids and parents bend over her. Let's see if we can either work on Summer being okay with it and work on teaching your clients appropriate ways of interacting with dogs to reduce social pressure." These experiences are invaluable, and it is not uncommon for me to have another OT or somebody else in the animal-assisted therapy world come and do a rotation at the clinic. These things are done to prevent animal stress and fatigue and build a better platform for our animals.

We also want to look at the familiarity with future practice settings in the absence of clients. If you are just starting, it is a good idea to take your dog after hours or on the weekends to the treatment environment to hang out. Take whatever your dog finds enjoyable and have fun with them. You chill and relax while they begin to understand the sights, smells, and sounds. Then, you can start to take them with just staff present. This can take several sessions and baby steps to get your dog used to the environment. 

This is the same thing when working with other therapists. Many programs have one dog working for several therapists, which can get crazy for the dog's schedule. The dogs in our clinic only work for 10 to 15 minutes out of the hour, and that is it. And, sometimes, they only work two or three sessions per day. You only want to add on one session or one therapist at a time. Make sure you are with them initially until your animals are comfortable and you know that the person has the skills to work with your animal. 

Animal-Assisted Interventions Planning-Application of AAT Skills

  • Ongoing professional development
  • 3rd party evaluation of professional human-animal team in setting, with population & activities (or simulate)
  • Formal evaluation of potential participants
  • Staff in-services
  • Practitioner able to demonstrate AAT/AAE within the scope of practice and using discipline-specific frames of reference, theories, or models

After training to learn specific intervention activities and documentation, you need to be evaluated. Even if you do some great volunteer visiting evaluations and/or a Canine Good Citizen program, you still need to have somebody watch your animal in a session or a mock session in the environment with the specific population. This is especially important if your dog will be working with pediatrics. You need somebody with training in animal behavior to observe your animal with a child to make sure that you are not missing things. Again, we love our animals, and it is easy for us to miss some of their subtle communication.

We also want to establish rules of engagement for future clients. All of the dogs in our practice have a book like this. Figure 6 is Phoebe's dog.

Figure 6

Figure 6. Phoebe's dog Summer.

This book talks about the specific dog, their breed, their age, where they like to be petted, and basic rules like if a dog is sleeping, you do not engage with it. Or, if a dog is in a crate, you do not engage with it. Also, nobody is allowed in crates unless we are cleaning them and the dogs are not in them. Crates should be a very safe place for the animals to go. This gives them very clear communication that this is where they can go and rest to be away from people. The book also talks about the best ways to give treats or their favorite therapy activities. "Here is what you should expect in working with Summer, and here is what Summer expects of you."

Do formal evaluations of potential participants, including their phobias, allergies, and a whole number of things. Screening participants is an entirely different course, but you want to ensure that your clients are appropriate. You also want to make sure that you give staff in-services so that everybody understands the dog's role. You do not want them to grab your dog to work with a client because they think they are a good candidate. Your dog should be scheduled to get breaks for their welfare and decrease liability.

Practitioners should also get animal-assisted therapy or education within the scope of practice and use discipline-specific frames of reference, theories, and models. You need to know that using a dog in a session does not constitute therapy.

  • Formal intervention plans for goal areas that may include AAT
  • Animal welfare & well-being implementation
  • Documentation for service delivery & client progress
  • Program implementation, evaluation, review, & development
  • Brief initial introductions between animal & participants

Can you measure client performance? Is the activity working on one of the client's goals? What is your goal? In some cases, the goal is breaking the ice and establishing rapport. That is great, but we also want to look at formal intervention plans for goal-directed areas that may include animal-assisted therapy. You need to have a written-out plan available for anybody who wants to see that includes how you structure your session, promote animal welfare/well-being, and document service delivery. Remember, you document client performance and progress, not what the dog does. 

We do weekly documentation for every one of our dogs. If Phoebe works with one of my dogs, she documents this in a log once a week. "Gertrude did X, Y, and Z." This information may tell me (and the rest of the staff) that Gertrude was concerned about a balloon that was in the room. As she is not usually afraid of balloons, this information about a shiny metal one is essential. I can then work with Gertrude on this.

It is essential to look at program implementation, evaluation, review, and development. You are changing risk assessment and maintenance plans all the time.

A brief initial introduction between an animal and the participants can give you a lot of information like if an individual is going to harm the animal if an individual is going to monopolize the animal's time, et cetera. Figure 7 shows a sample of what one of our session plans would look like for animal-assisted therapy. You can go over it at your leisure, but you should be able to answer all of these questions. 

Figure 7

Figure 7. Sample session plan. Click the link for an enlarged image.

Summary

We have discussed a tiered approach to animal-assisted therapy, including resource building, preparatory phase, supervision/mentoring, and then applying those skills and re-evaluating them over time. Is this intervention as effective as you hoped it would be? What do you need to change about your program?

It is crucial to work with a qualified person in animal behavior as not every dog will like these activities. If you do not know breed-specific traits and precisely what you expect your dog to do, it can be a disaster. It is like match.com. You have a job description and need to figure out animal has the skills and interest to do it. Some dogs need more activity, especially when they are younger. They may not be appropriate in some contexts but may do very well in others like a juvenile detention center, where they are running and playing. 

If your dog is having some issues in your clinic, try and figure out the source of it. Using occupational therapy activity analysis, we may need to modify the dog, the client's interactions, or the activity. Animal-assisted intervention fits within our scope of practice. We wish nothing but the best for you and hope that you are successful in all of your endeavors.

Questions and Answers

Can we request that a dog participate in animal-assisted therapy with our patients as needed? Do you have general guidelines for OT interventions utilizing animal-assisted therapy, especially ADL interventions?

Yes, there are so many interventions. For instance, with dressing skills, they may work on strengthening activities with the dog to enable them to do fasteners. Some of our clients wear Velcro shoes, but they do not have the strength or the grip to unfasten those. Dogs with identification vests, collars, or leashes may also have Velcro, which would be a great way to work on that. We also have many small containers with zippers, snaps, or Velcro, and we tuck a piece of dog kibble in each one. If the client is not interested in cooking for themselves because they are depressed or bummed, they may be willing to surf the internet for dog treat recipes. They can then write out the recipe, shop for it, and bake the treats. There are many different ways to use dogs in treatment; the sky is the limit. Many resources like Animal Assisted Intervention International, "Human-Animal Interaction Bulletin," workshops by well-known in the field, et cetera. 

I love the idea of a profile book on each dog. I think that is ingenious. I especially liked how you talked about incorporating activity analysis on what the dog likes and the goals because it is essential for that interaction.

Everybody needs to enjoy their work, so we need to ensure that we keep our dogs as interested as our clients.

Can an OTA become certified for animal-assisted therapy?

This is an interesting question. Right now, there is no governing body that has the power to certify anybody. We all went to school, but it was not until we took our boards by a governing body that we became certified. So, we have to be careful with the word "certified." Occupational therapy assistants can and do animal-assisted therapy. You need continuing education, you need to be evaluated, and your dog needs to be assessed. For a long time, only volunteer visiting organizations were doing evaluations for therapy dogs. However, our job as occupational therapy assistants or occupational therapists is very different from what volunteers do. Why would we rely on a test for a volunteer job versus for therapy? I know that Pet Partners is working on a test for a professional level that will be coming out soon. But again, your dog will not be certified.

Suppose there is a dog that passed the Canine Good Citizen training and will test through the Alliance of Therapy Dogs Associations. Can you give me some resources for mentorship to continue the training?

I recommend that you check and see how they offer a certification versus registration. Who gave this entity the power to certify? It could be an internal certification but check on that. Animal Assisted Intervention International offers some great things that come with their membership explicitly built for people working in practice. The disclaimer is that I am one of the founders and current president of that organization. I am one of the founding members. I also think that the "Human-Animal Interaction Bulletin" is part of the American Psychological Association. It is free, and they give webinars, have journal clubs, and many different resources. Several universities teach college-level courses for animal-assisted therapy. Oakland University is one of them. Another disclosure is that I work there. There is also one in Colorado that is in their social work curriculum. You can even check in on the Animal Assisted Intervention International Facebook group. We are constantly posting freebies on there.

What is the difference between animal-assisted activity, animal-assisted education, and animal-assisted therapy? I am also wondering about the term "intervention."

Animal-assisted intervention is an umbrella term that includes animal-assisted activity, animal-assisted education, and animal-assisted therapy. Animal-assisted intervention is an umbrella term describing a volunteer, educator, or professional that incorporates animals into their practice. Animal-assisted activity is a volunteer visit where a dog is there to say hello, get pets, and have recreational purposes. With education, you have a licensed and degreed professional who provides goal-directed activities specific to their educational goals for that individual. Finally, animal-assisted therapy is completed by a licensed or degreed professional trained in therapy to provide interventions that focus on cognitive, psychosocial, and physical interventions for particular individuals.

Does insurance cover animal-assisted therapy?

You had better make sure it is. I have four different sets of insurance within my practice for different purposes. People must understand what their policies cover, what they do not cover, and what you need to write in. This also requires a conversation with your business liability insurance. Here in New Mexico, we do not get a whole lot of rain, sleet, snow, hail, or any of that, but I still have slip and fall insurance just in case that one time a year that it does snow. At the same time, I also have a rider for my dogs on site. If a neighbor kid sticks their hand through a fence and it is covered in Cheetos or chicken from their lunch, and one of my dogs mistakenly bites them, my insurance is going to cover that. This is where your formal risk assessment and management plan comes in. 

Citation

Winkle, M. & Yam, P. (2022). Animal-assisted therapy as an adjunct to OT. OccupationalTherapy.com, Article 5487. Available at www.occupationaltherapy.com

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melissa winkle

Melissa Winkle, OTR/L, FAOTA, CPDT-KA

President, Dogwood Therapy Services

Melissa Y. Winkle OTR/L, FAOTA, CPDT-KA is both an Occupational Therapist & a Certified Professional Dog Trainer. She is co-founder and President of Dogwood Therapy Services, a private practice in Albuquerque, NM; and of Animal Assisted Intervention International, a European-based organization for healthcare and human service providers who include animals in professional practice. She is adjunct faculty and clinical instructor at several universities and organizations, where she designs and delivers curriculum. Melissa is a practitioner, a researcher, an author and speaks internationally about disability, integrated & community-based program development, animal-assisted interventions, and service dogs. She is a proud UNM OT Program Alumni and a Fellow of the American Occupational Therapy Association. 


phoebe yam

Phoebe Yam, OTD, OTR/L

Phoebe Yam OTD, OTR/L is an occupational therapist from Arcadia, California who graduated from the University of Southern California. She has dedicated the past 3 years at Dogwood Therapy Services to pursue her goal of specializing in animal assisted therapy. She enjoys working with people of all abilities and ages. Phoebe has been studying the effect of training and handling styles on the human-animal relationship and enjoys learning about how to strengthen the human animal bond. She has presented at state and national conferences on achieving competency and standards of practice to further the field of animal assisted therapy for healthcare and human service providers.



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